Abstract
Background: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods: We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016–February 2017) and post-MDC implementation (February 2017–December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results: We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs.
Highlights
Lung cancer (LC) is the leading cause of cancer-related mortality [1] and is associated with significant health system resource utilization [2,3,4,5]
There have been no studies to date that assess the clinical efficiencies achieved through quality improvement (QI) in an LC Multidisciplinary LC Clinic (MDC), and few studies evaluating the health resource utilization and secondary patient benefits achieved through LC MDC models [3]
This subsequently increased to a maximum of 6.0 patients/clinic in December 2018 in response to increased intake of non-Lung Diagnostic Assessment Program (LDAP) managed patients and identification of patients that would benefit from multidisciplinary care
Summary
Lung cancer (LC) is the leading cause of cancer-related mortality [1] and is associated with significant health system resource utilization [2,3,4,5]. Multidisciplinary cancer clinics (MDC) have increasingly been shown to have several benefits in LC care, including: improved care coordination, communication between providers, and compliance with guideline-recommended care; reduced delays in time to diagnosis and treatment; and reduced healthcare costs from improved resource utilization, fewer patient visits, and reduced out-of-pocket costs for patients [3,4,5,11,12,13,14,15]. There have been no studies to date that assess the clinical efficiencies achieved through quality improvement (QI) in an LC MDC, and few studies evaluating the health resource utilization and secondary patient benefits achieved through LC MDC models [3]. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs
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